Provider Demographics
NPI:1437800166
Name:RAZAVI, ARTA
Entity type:Individual
Prefix:
First Name:ARTA
Middle Name:
Last Name:RAZAVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 A ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3010
Mailing Address - Country:US
Mailing Address - Phone:619-994-3503
Mailing Address - Fax:
Practice Address - Street 1:809 A ST APT 2
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3010
Practice Address - Country:US
Practice Address - Phone:619-994-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst